Thread by @JJheart_doc

In one month, I've diagnosed more cases of ATTR cardiomyopathy than I did in 10 years. If you don't look for it, you won't find it.

A micro-tweetorial...

What should you look for?

@HannaGaggin @frederickruberg

--unexplained mild "LVH"
--PAF that has little explanation
--spinal stenosis
--carpal tunnel
--orthostatic hypotension
--bruising
--lack of EF response to #GDMTworks
--Diuretic sensitivity
--Higher biomarkers "than they should be"

Why are biomarkers higher in amyloid? It has mainly to do with direct myocardial toxicity of the amyloid protein, and NOT congestion/ischemia in most cases.

hs-cTn is almost universally elevated.

Both NPs and hs-cTn are prognostic, regardless of their 'decoupling' from HF/MI.

I have dx'd people without HF symptoms on the basis of some of the above findings.

Think of the diagnosis, because if you don't, you won't recognize it until it's later in the process.

This is important because treatments for ATTR are most effective EARLY in the disease course.

With other treatments coming, early and definitive diagnosis is really important.

@Ron_Witteles has written a lot on the careful evaluation of possible ATTR in this excellent paper: pubmed.ncbi.nlm.nih.gov/31302046/

Remember that AL is possible with an abnormal pyrophosphate scan!